Pathology/Lab Coding Alert
Test Your ISH Coding Skills
Example 1: A pathologist performs a FISH test on breast tissue to detect amplification of the HER-2/neu gene. The procedure uses two DNA probes and involves quantifying signals from the probes in 100 tumor-cell nuclei using ChromaVision Automated Cellular Imaging System (ACIS). The pathologist evaluates the hybridization ratio and interprets the test as negative for amplification of the HER-2/neu gene.
Solution 1: Because the ISH morphometric analysis uses computer-assisted technology, you should report this service using 88367 (Morphometric analysis, in situ hybridization [quantitative or semi-quantitative], each probe; using computer-assisted technology). The test involves two separate DNA probes, so you should bill two units of CPT 88367 .
Example 2: Based on Pap smear ASCUS results, the lab performs a Ventana INFORM HPV test on the cervical cytology specimen. The method involves fluorescence in situ hybridization using a probe for high-risk HPV genotypes. The pathologist examines hybridized cells and interprets the test as positive or negative for HPV infection.
Solution 2: Because the result is qualitative for this cervical cytology HPV FISH test, you should report the service as 88365 (In situ hybridization [e.g., FISH], each probe). The pathologist reports "positive" or "negative," meaning that the analysis doesn't lead to a quantitative or semiquantitative result involving morphometric analysis.
Example 3: A physician performs a nasopharyngoscopy with biopsy of a mass found in a patient presenting with nasal bleeding and obstruction. As part of the tissue examination, the pathologist analyzes stained slides using chromogenic in situ hybridization (CISH) of RNA probes specific for Epstein Barr virus (EBV). The pathologist examines the slides and provides the interpretation that the CISH test demonstrates the presence of EBV in the tumor cells, indicating nasopharyngeal carcinoma.
Solution 3: You should report the pathologist's tissue exam as 88305 (Level IV - Surgical pathology, gross and microscopic examination, nasopharynx/oropharynx, biopsy). For the qualitative CISH evaluation that the pathologist uses to establish the presence of EBV, you should report 88365 as an adjunct service to the surgical pathology code 88305. Because the 88365 code definition uses FISH as an example, the description does not exclude using the code for other ISH techniques, including CISH.
- Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc. in Simpsonville, Ky., helped prepare these examples and solutions.
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